by Erin Digitale
Illustration by Brian Cronin
David Stevenson, MD, wouldn’t mind putting himself out of business.
Over the last 30 years, Stevenson’s field, neonatology, has undergone a giant shift. New inventions such as better treatments for newborn jaundice and for preemies’ immature lungs now allow doctors to save many early arrivals who would once have died.
But preemies’ stories don’t end when they leave the neonatal intensive care unit. Many of these survivors — born between three and 18 weeks early — endure lifelong health problems, such as cerebral palsy, developmental delays and impaired vision and hearing. So Stanford scientists, led by Stevenson, are taking a new approach: attempting to prevent preterm birth altogether. They want to get to the bottom of a dramatic, and largely unexplained, increase in preterm births, which have risen 30 percent in the United States since 1981.
By helping women carry their pregnancies to term, “We hope to obviate the need for what we’ve already invented,” says Stevenson, vice dean of the School of Medicine and director of the Johnson Center for Pregnancy and Newborn Services at Lucile Packard Children’s Hospital.
One in eight infants is now born early, for a total of a half-million preemies per year. Though some of the increase is explained by other changes — rising maternal age, more maternal obesity and more multiple births due to fertility treatments — about half of preterm deliveries happen for reasons unknown.
Courtesy of March of Dimes
“There’s a clear need for new research that addresses this challenging public health problem,” says Stevenson. He is directing a new center, launched this spring by the March of Dimes Foundation, to understand what triggers preterm birth, predict which women are at risk and translate the new knowledge into strategies to prevent early delivery. The March of Dimes Prematurity Research Center at Stanford University School of Medicine will bring together experts from fields such as obstetrics, sociology, bioinformatics, engineering and public health. The foundation is donating $2 million per year for 10 years to support their work.
One planned project will examine how infection triggers preterm birth. It’s already known that infection in the uterus can cause early labor, but the mechanism is unclear. In addition, it appears that various forms of disturbance in the communities of microbes that normally inhabit the human body may also lead to early labor. David Relman, MD, professor of medicine and of microbiology and immunology at Stanford, will lead the effort to characterize the microbes that cause these infections and understand how maternal immune responses trigger early labor.
The new center is the first of its kind; March of Dimes may eventually sponsor others as its funding permits. In addition to the broad expertise of its leaders, center research will employ state and national information, including California Perinatal Quality Care Collaborative statistics and the U.S. Standard Certificates of Live Birth data set. These comprehensive resources have the advantage of surveying large populations, giving a more nuanced view than researchers can obtain with small studies at individual hospitals.
The research team ultimately aims to replace high-tech NICU wizardry with methods to stop babies from being born early in the first place.
“As neonatologists, we’ll be glad to see this change,” Stevenson says.